Amounts of coronary arterial narrowing by atherosclerotic plaques in clinically isolated mitral valve stenosis: Analysis of 76 necropsy patients older than 30 years

Abstract

Although several studies have described the status of the coronary arteries by angiography in patients with mitral stenosis (MS), few necropsy studies of the coronary arteries in these patients are available. The present report describes in detail the amounts of narrowing by atherosclerotic plaque of the 4 major epicardial coronary arteries in 76 necropsy patients, aged 31 to 79 years (mean 53) with clinically isolated MS (with or without associated mitral regurgitation but without aortic valve dysfunction). Of the 76 patients, ≥1 major coronary artery was narrowed >75% in cross-sectional area (XSA) in 38 (50%) and in 10 of the 38 patients ≥1 major coronary artery was totally occluded or nearly so (>95% XSA narrowing). A higher percent of the 29 men had significant (>75% XSA) coronary narrowing than did the 47 women (62 vs 44%) and the men had more major coronary arteries significantly narrowed compared with the women (31 of 116 arteries [27%] vs 33 of 188 arteries [18%]). The 4 major coronary arteries in the 76 patients were divided into 5-mm segments and examined histologically: of the 3,124 segments (41 per patient), 620 segments (20%) were narrowed 0 to 25% in XSA, 1,826 (58%) were narrowed 26 to 50%, 470 (15%) were narrowed 51 to 75%, 188 (6%) were narrowed 76 to 95%, and 20 segments (1%) were narrowed 96 to 100% in XSA. The percent of segments narrowed >75% in XSA was 9% in the men and 5% in the women. The percent of segments narrowed >75% in XSA was highly variable in the 38 patients with significant narrowing, ranging from 2 to 59% (mean 13%). Grossly visible left ventricular scars were present in 11 patients and in each they involved the posterior (inferior) wall; 8 of the 11 patients had significant coronary narrowing and 3 did not. Angina pectoris was present in 13 patients, 8 (62%) had significant coronary narrowing and 5 (38%) did not.